Cost Effectiveness and Resource Allocation最新文献

{"title":"IAPN: a simple framework for evaluating whether a population-based risk stratification tool will be cost-effective before implementation.","authors":"Steven Wyatt, Mohammed A Mohammed, Peter Spilsbury","doi":"10.1186/s12962-024-00594-5","DOIUrl":"10.1186/s12962-024-00594-5","url":null,"abstract":"<p><p>Risk prediction tools are widely used in healthcare to identify individuals at high risk of adverse events who may benefit from proactive interventions. Traditionally, these tools are evaluated primarily on statistical performance measures-such as sensitivity, specificity, discrimination, and positive predictive value (PPV)-with minimal attention given to their cost-effectiveness. As a result, while many published tools report high performance statistics, evidence is limited on their real-world efficacy and potential for cost savings. To address this gap, we propose a straightforward framework for evaluating risk prediction tools during the design phase, which incorporates both PPV and intervention effectiveness, measured by the number needed to treat (NNT). This framework shows that to be cost-effective, the per-unit cost of an intervention (I) must be less than the average cost of the adverse event (A) multiplied by the PPV-to-NNT ratio: I < A*PPV/NNT. This criterion enables decision-makers to assess the economic value of a risk prediction tool before implementation.</p>","PeriodicalId":47054,"journal":{"name":"Cost Effectiveness and Resource Allocation","volume":"22 1","pages":"90"},"PeriodicalIF":1.7,"publicationDate":"2024-12-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11616102/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142781428","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Cost of the national malaria control program and cost-effectiveness of indoor residual spraying and insecticide-treated bed net interventions in two districts of Madagascar.","authors":"Voahirana Tantely Annick Andrianantoandro, Martine Audibert, Thomas Kesteman, Léonora Ravolanjarasoa, Milijaona Randrianarivelojosia, Christophe Rogier","doi":"10.1186/s12962-024-00598-1","DOIUrl":"10.1186/s12962-024-00598-1","url":null,"abstract":"<p><strong>Background: </strong>Madagascar has made significant progress in the fight against malaria. However, the number of malaria cases yearly increased since 2012. ITNs and IRS are key interventions for reducing malaria in Madagascar. Given the increasing number of cases and limited resources, understanding the cost-effectiveness of these strategies is essential for policy development and resource allocation.</p><p><strong>Methods: </strong>Using a societal perspective, this study aims to estimate the cost of the National Malaria Control Program (NMCP) through the first national malaria strategic plan (implemented over the period 2009-2013) and to assess the cost-effectiveness of two individually implemented malaria control interventions (ITNs and IRS) in two districts, Ankazobe and Brickaville. The cost-effectiveness ratio (CER) of ITN intervention was then compared to the CER of IRS intervention to identify the most cost-effective intervention. The cost of the NMCP and the costs incurred in the implementation of each intervention at the district level were initially estimated. On the basis of two results, the CERs of ITN or IRS correspond to the total cost of ITN or IRS divided by the number of people protected or the number of disability-adjusted life years (DALYs) averted. A deterministic univariate sensitivity analysis was conducted to assess the robustness of the results with a discount rate of 2.5% (0-5%) (costs and DALYs) and a 95% CI (person protected).</p><p><strong>Results: </strong>From 2009 to 2013, the NMCP cost USD 45.4 million (USD 43.5-47.5, r = 0-5%) per year, equivalent to USD 2.0 per capita per year. IRS implementation costs were four times higher than those of ITNs. The CER of IRS per case protected (USD 295.1 [285.1-306.1], r = 0-5%) was higher than the CER of ITNs (USD 48.6 [USD 46.0-51.5, r = 0-5%] in Ankazobe and USD 26.5 [USD 24.8-28.4, r = 0-5%] in Brickaville). The CERs per DALY averted of IRS was USD 427.6 [USD 413.0-546.3, r = 0-5%] in Ankazobe and, for ITNs, it was USD 85.4 [USD 80.8-90.5, r = 0-5%] in Ankazobe and USD 45.3 [USD 42.2-48.4, r = 0-5%] in Brickaville. Compared to the country GDP per capita (USD PPP 1494.6 in 2013), ITN intervention was \"highly cost-effective\" while the CER for IRS interventions was sensitive to parameter variation (CI, 95% of persons protected), which ranges from highly cost-effective to only cost-effective (USD 291.5-2004, r = 2.5%).</p><p><strong>Conclusion: </strong>In the Malagasy context, IRS intervention cost more and was less effective than ITN intervention. Willingness to pay for IRS is questioned. A relevant budget impact analysis should be conducted before a potential extension of this intervention.</p>","PeriodicalId":47054,"journal":{"name":"Cost Effectiveness and Resource Allocation","volume":"22 1","pages":"89"},"PeriodicalIF":1.7,"publicationDate":"2024-12-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11616307/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142773569","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Controversies in implementing the exemption policy for the elderly healthcare services in Tanzania: experiences from the priority setting process in two selected districts.","authors":"Malale Tungu, Nathanael Sirili, Alphoncina Kagaigai, Pankras Luoga, Novatus Tesha, Thadeus Ruwaichi, Gasto Frumence","doi":"10.1186/s12962-024-00595-4","DOIUrl":"10.1186/s12962-024-00595-4","url":null,"abstract":"<p><strong>Background: </strong>Health financing system in Tanzania changed in the early 1990s as a result of the introduction of cost-sharing policies by the 1990s health sector reforms. The reforms brought about user fees which has led to inequity in access to health care services and catastrophic health expenditure among the elderly. In efforts to reduce the inequity gap among vulnerable groups, in 1994, the government introduced an exemption and waiver policy. More than three decades later, inequity in health care services access has persisted with the elderly population being more affected. The latter poses questions on the implementation efficiency of the exemption policy. We aimed to assess the implementation of the exemption policy on access to health services among the elderly in Tanzania by learning from the experiences of the priority setting process in two districts of western Tanzania.</p><p><strong>Methods: </strong>An exploratory qualitative case study adopting Key informant interviews (KIIs) was used to collect data in Nzega and Igunga districts. The key informants involved the representatives of the planning team and decision makers from the community, health facility and district level. Information saturation was attained after the 24th interview and thus data collection ended. The content analysis approach was used to analyse the data.</p><p><strong>Findings: </strong>Although there is a designated office that deals with exemptions for the elderly in health facilities, there are challenges in accessing health services. The challenges include insufficient drugs, some laboratory tests not covered by the exemption, a lengthy process to access service, poor financial mechanisms for exempted services, inadequate information and clarity of the exemption categories, and limited to no involvement of different stakeholders in the exemption process.</p><p><strong>Conclusion: </strong>The exemption policy was introduced to help disadvantaged groups, including the elderly. However, its implementation encountered challenges which burden both the elderly and the health facilities. Its implementation has thus become a controversy to its initial aim that was to relieve the elderly from high healthcare costs. Revisiting the policy through a thorough stakeholders' engagement and establishing alternative financing of the exemption policy are recommended.</p>","PeriodicalId":47054,"journal":{"name":"Cost Effectiveness and Resource Allocation","volume":"22 1","pages":"88"},"PeriodicalIF":1.7,"publicationDate":"2024-12-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11613900/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142773559","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Assessing diagnosis-related groups based direct medical expenditures of chronic disease patients in general hospital of lower southern Thailand.","authors":"Akemat Wongpairin, Apiradee Lim, Phattrawan Tongkumchum, Wichayaporn Thongpeth, Haris Khurram","doi":"10.1186/s12962-024-00596-3","DOIUrl":"10.1186/s12962-024-00596-3","url":null,"abstract":"<p><strong>Background: </strong>Assessment of the cost-related burden of chronic diseases is important for making informed decisions. An effective and efficient methodology for examining medical expenditures is one of the most significant challenges for stakeholders. The objective of this study was to examine the role of the variables of diagnosis-related group (DRG) in determining the direct expense of chronic diseases in lower southern Thailand and suggest the determinants having high explainability.</p><p><strong>Methods: </strong>The records of 6,147 patients admitted to Satun Hospital from 2014 to 2018 and diagnosed with chronic conditions were analyzed in this study. Descriptive analysis was used to summarize the main characteristics. Correlation was used to analyze the strength of the relationship. A log-linear regression model was used to evaluate the adjusted mean cost using determinants of DRG.</p><p><strong>Results: </strong>The overall average medical expense for chronic disease was Thailand Baht (THB) 17,985. Chronic kidney and chronic obstructive pulmonary diseases were the most expensive chronic diseases with an average expense of about THB 20,000 and 25,000. All the determinants were significantly contributing to overall expense of chronic disease with a p-value < 0.001. However, the length of stay, number of diagnoses, and number of procedures had high explainability in the expense model.</p><p><strong>Conclusions: </strong>The expense assessment model plays a significant role in controlling and preventing the medical costs associated with chronic diseases. Healthcare administrators, stakeholders, and researchers need to make strategies by considering the results of this study to improve the DRGs-based hospital cost model.</p>","PeriodicalId":47054,"journal":{"name":"Cost Effectiveness and Resource Allocation","volume":"22 1","pages":"87"},"PeriodicalIF":1.7,"publicationDate":"2024-11-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11603977/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142740990","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Health system efficiency and equity in ASEAN: an empirical investigation.","authors":"Yaqing Liu, Liwen Gong, Haoran Niu, Feng Jiang, Sixian Du, Yiyun Jiang","doi":"10.1186/s12962-024-00588-3","DOIUrl":"10.1186/s12962-024-00588-3","url":null,"abstract":"<p><strong>Background: </strong>Equity and efficiency are two fundamental principles for the sound development of health systems, as advocated by the World Health Organization (WHO). Despite the notable progress made by the Association of Southeast Asian Nations (ASEAN) in advancing their health systems, gaps persist in achieving global health goals. This paper examines the efficiency of health system stages and the fairness of health resource distribution in ASEAN countries, analyzes the underlying causes of the existing gaps, and suggests potential solutions to bridge them.</p><p><strong>Methods: </strong>Data spanning 2011 to 2019, sourced from the WHO Global Health Observatory and the World Bank Database, form the foundation of this study. This study employs an enhanced two-stage data envelopment analysis (DEA) to assess the efficiency of health system stages in ASEAN countries. Equity in health resource distribution is evaluated using health resource agglomeration degree and concentration curves across demographic, geographic, and economic aspects. Furthermore, the Entropy-Weighted TOPSIS method is utilized to integrate equity across these dimensions, measuring the overall fairness in health resource allocation across different countries. Finally, rankings of health system fairness and efficiency are compared to assess the overall development level of health systems.</p><p><strong>Results: </strong>The overall efficiency of the ASEAN health systems from 2011 to 2019 averaged 0.231, with an upward trend in the first stage efficiency at 0.559 and a downward trend in the second stage at 0.502. The health resource agglomeration degree indicated that Singapore, Brunei, and Malaysia had HRAD and HRPD values significantly greater than 1, and Cambodia, Myanmar, and Laos predominantly had indices significantly less than 1. The concentration curve for hospital beds was the closest to the line of absolute equity. During the study period, the health resource concentration curve increasingly approached absolute equity, shifting from above to below the concentration curve. Singapore, Brunei, and Malaysia consistently remained in the first quadrant of the quadrant plot, and Myanmar and Cambodia were consistently in the third quadrant.</p><p><strong>Conclusion: </strong>ASEAN countries face two key challenges in their healthcare systems: first, while many nations such as Indonesia, Thailand, and Vietnam have improved resource allocation efficiency, this hasn't yet translated into better health services. To address this, establishing national health sector steering committees, focusing on workforce training and retention, and implementing centralized monitoring systems are crucial. Second, there is a growing disparity in healthcare development across ASEAN. Promoting balanced resource distribution and leveraging ASEAN's economic integration for regional collaboration will help bridge these gaps and foster more equitable healthcare systems.</p>","PeriodicalId":47054,"journal":{"name":"Cost Effectiveness and Resource Allocation","volume":"22 1","pages":"86"},"PeriodicalIF":1.7,"publicationDate":"2024-11-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11590474/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142716429","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Coverage and distributional benefit-cost of rotavirus vaccine in Uganda: an analysis of routine health facility aggregated data.","authors":"Rornald Muhumuza Kananura, Gatien de Broucker, Anthony Ssebagereka, Aloysius Mutebi, Elizabeth Ekirapa Kiracho, Bryan Patenaude","doi":"10.1186/s12962-024-00586-5","DOIUrl":"10.1186/s12962-024-00586-5","url":null,"abstract":"<p><strong>Introduction: </strong>Owing to the lack of local cost and clinical effectiveness data in sub-Saharan Africa, economic evaluations of the rotavirus vaccine are still limited in the region. In this study, we utilize different data sources, including aggregated routine health information system data to examine the net benefits of the rotavirus vaccine in Uganda. We also present ways in which health facility data can be used to assess subnational vaccination coverage as well as the effect of the vaccine on diarrhoea hospitalization.</p><p><strong>Methods: </strong>We used monthly health facility data collected between 2015 and 2021 to study the relationship between rollout of rotavirus vaccine and diarrhoea hospitalization. We gathered information from empirical studies on the cost of diarrhoea (household and health facility) and vaccine administration to estimate the costs averted due to the rotavirus vaccine. As household costs, we considered out-of-pocket payments associated with the episodes of diarrhoea and the productivity loss associated with time spent on treatment and with mortality using a human capital approach. Finally, we employed an interrupted time series analysis to examine the effect of rotavirus vaccine on diarrhoea hospitalization. Costs are presented in 2018 US dollars.</p><p><strong>Results: </strong>As of 2021, nationwide coverage of the first and second doses of the rotavirus vaccine (RV) in Uganda was estimated at 89% and 65% respectively, with variations observed across the regions. The study revealed a decrease in diarrhoea hospitalization by 1% for each 1% increase in RV coverage. Moreover, the study showed that diarrhoea hospitalization reduced by 2% for each additional month post- vaccine rollout. Excluding productivity losses due to mortality, the analyses of costs averted due to the RV reveal that between 2018 and 2021, Uganda saved approximately $57 million ($7 per capita) in expenses associated with diarrhoea. The return on investment (ROI) due to RV was calculated to be $1.48 per dollar invested. When including mortality costs, the net benefit reached up to $3 billion in economic cost ($385 per capita), and an ROI of $78 overall. Furthermore, the study demonstrated that RV provided substantial health benefits, particularly for socially disadvantaged groups. Excluding mortality costs, the ROI for the two most disadvantaged groups ranged from $1.71 to $2.03 per dollar spent, while for the remaining groups, it ranged from $1.10 to $1.14.</p><p><strong>Conclusion: </strong>This manuscript stresses the importance of RV in alleviating the burden of diarrhoeal diseases and associated costs in Uganda. The study not only emphasizes the tangible benefits derived from the vaccine but also highlights the role of routine aggregated healthcare information systems in systematically monitoring the effectiveness and coverage of interventions.</p>","PeriodicalId":47054,"journal":{"name":"Cost Effectiveness and Resource Allocation","volume":"22 1","pages":"85"},"PeriodicalIF":1.7,"publicationDate":"2024-11-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11583679/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142692762","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Cost-effectiveness of fenofibrate for preventing diabetic complications in Australia.","authors":"Hansoo Kim, Juntao Lyu, Vikrama Raja, Kyoo Kim","doi":"10.1186/s12962-024-00591-8","DOIUrl":"10.1186/s12962-024-00591-8","url":null,"abstract":"<p><strong>Background: </strong>This study investigated the cost-effectiveness of using fenofibrate to treat type 2 diabetes in Australia. The financial burden of type 2 diabetes mellitus is estimated to surpass AUD10 billion, mainly due to the cost of diabetic complications from diabetic neuropathy. Clinical evidence from the Fenofibrate Intervention and Event Lowering in Diabetes (FIELD) study demonstrated that fenofibrate can reduce the risk of amputation and other diabetes-related complications.</p><p><strong>Methods: </strong>This study used a calibrated UKPDS model with an Australian diabetes cohort to simulate complications and deaths over a 20-year time horizon. The effectiveness of fenofibrate was assessed using the FIELD study. Total cost was calculated over the 20-year time horizon. Input data was obtained from the Australian Refined-Disease Related Groups and the Australian Pharmaceutical Benefits Scheme.</p><p><strong>Results: </strong>The model estimated that fenofibrate is associated with lower complication costs, which save over AUD 4.6 million per 1,000 patients. The most significant savings were observed in amputations. The incremental cost-effectiveness ratio for fenofibrate treatment was estimated to be AUD 739/LY gained and AUD 1189/QALY gained.</p><p><strong>Conclusion: </strong>The use of fenofibrate in Type 2 diabetes patients is estimated to result in cost savings in an Australian setting due to fewer diabetes complications.</p>","PeriodicalId":47054,"journal":{"name":"Cost Effectiveness and Resource Allocation","volume":"22 1","pages":"84"},"PeriodicalIF":1.7,"publicationDate":"2024-11-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11575035/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142669303","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Cost-effectiveness of high-dose vitamin D supplementation to reduce the occurrence of repeat episodes of pneumonia in children.","authors":"Jefferson Antonio Buendía, Diana Guerrero Patiño","doi":"10.1186/s12962-024-00589-2","DOIUrl":"10.1186/s12962-024-00589-2","url":null,"abstract":"<p><strong>Introduction: </strong>Despite the growing evidence on efficacy, little is known regarding the efficiency of Vitamin D supplementation (VDS) to reduce the incidence of repeat episodes of pneumonia in children. This study aimed to determine the cost-utility of VDS to reduce the incidence rate of repeat episodes of pneumonia in children.</p><p><strong>Methods: </strong>A decision tree model was used to estimate the cost and quality-adjusted life-years (QALYs) of VDS in a patient aged 2 to 60 months with a clinical diagnosis of community-acquired pneumonia requiring in-hospital management. Multiple sensitivity analyses were conducted to evaluate the robustness of the model. Cost-effectiveness was evaluated at a willingness-to-pay (WTP) value of US$5180.</p><p><strong>Results: </strong>The QALYs per person were 0,93 with VDS and 0,92 without VDS. The total costs per person were US$ 1148 for VDS and US$ 1284 without VDS. This position of absolute dominance of VDS makes it unnecessary to estimate the incremental cost-effectiveness ratio. The ICER was sensitive to changes in the relative risk of Vitamin D supplementation.</p><p><strong>Conclusion: </strong>In conclusion, our study shows that VDS is a cost-effective to reduce the incidence rate of repeat episodes of pneumonia in children, from a societal perspective. However, the sensitivity of ICER to relative risk makes it necessary to take the results of this economic evaluation with caution.</p>","PeriodicalId":47054,"journal":{"name":"Cost Effectiveness and Resource Allocation","volume":"22 1","pages":"83"},"PeriodicalIF":1.7,"publicationDate":"2024-11-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11566492/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142629604","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Cost-effectiveness analysis of Tocilizumab compared to Adalimumab in the treatment of severe active rheumatoid arthritis in Iran.","authors":"Yalda Metghalchi, Neda Yaghoubi, Nazila Yousefi, Razieh Ahmadi, Alireza Kargar, Marzieh Zargaran, Soheila Rezaei","doi":"10.1186/s12962-024-00592-7","DOIUrl":"10.1186/s12962-024-00592-7","url":null,"abstract":"<p><strong>Background and objective: </strong>This study aimed to determine the cost-effectiveness of Tocilizumab (TCZ) compared with Adalimumab (ADA) in patients with Rheumatoid Arthritis (RA), who had not responded to methotrexate (MTX), from a societal perspective in Iran.</p><p><strong>Method: </strong>To conduct the cost-utility analysis, using an individual microsimulation Markov model, a hypothetical cohort of 1,000 patients was evaluated over a lifetime horizon. The efficacy and safety of each treatment were estimated using the American College of Rheumatology (ACR) criteria to determine the continuation or switching of treatment every six months. Treatment responses were captured based on Health Assessment Questionnaire (HAQ) scores and mapped into utility values to determine QALY gained for each treatment. All direct and indirect costs associated with the disease and perspective were included according to societal perspective. Deterministic and Probabilistic sensitivity analyses were performed to assess the robustness of the model.</p><p><strong>Results: </strong>The result of the study estimated that TCZ is a more cost-effective treatment option, with a probability of 76%. TCZ was associated with a higher cost ($6,990 versus $6,608) and higher QALYs gained (4.24 versus 3.95) compared to ADA with an incremental cost-effectiveness ratio (ICER) of USD 1,301, which is below the willingness-to-pay threshold of 1,448 USD in Iran.</p><p><strong>Conclusion: </strong>This study provides convincing evidence of the cost-effectiveness of TCZ compared to ADA in the treatment of active severe RA in Iran.</p>","PeriodicalId":47054,"journal":{"name":"Cost Effectiveness and Resource Allocation","volume":"22 1","pages":"82"},"PeriodicalIF":1.7,"publicationDate":"2024-11-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11562510/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142629223","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"From pilot to national roll-out of the improved Community Health Fund (iCHF) in Tanzania: lessons learnt and way forward.","authors":"Ntuli A Kapologwe, Boniphace Marwa, Heri Marwa, Ally Kebby, James Tumaini Kengia, George Ruhago, Stephen M Kibusi, Innocent B Mboya, Gemini Mtei, Albino Kalolo","doi":"10.1186/s12962-024-00571-y","DOIUrl":"10.1186/s12962-024-00571-y","url":null,"abstract":"<p><strong>Introduction: </strong>Scaling up public health interventions in the health systems of resource poor settings come with technical and operational challenges. Little is documented on scaling up complex health financing interventions and their related outcomes, especially the voluntary health insurance schemes. This study aimed to analyse the scale-up steps, successes and challenges of the improved community health fund (iCHF), a voluntary health insurance scheme in Tanzania, METHODS: In this paper, guided by the Expand Net framework (a scale-up framework for health system interventions), we present a systematic analysis of countrywide scale-up of the iCHF that started in 2019 and implemented in partnership between the government and development partners. We systematically collected information on the scale-up steps and the success and challenges. The collected data was analysed using descriptive statistics.</p><p><strong>Results: </strong>The scale-up involved multiple steps and actions at different levels of the health system. The initial step involved gathering stakeholders' views on scale-up options and strategies. The subsequent steps focused on mobilizing resources for scale-up, advocacy and promotion of the scheme through media, community leaders and role models, capacity building to implementing organs, institutionalizing the scale-up processes, intensifying the scale-upscale-up activities for expansion and spontaneous scale-up and technical backstopping to lower levels of the health system on the scale-up process. We found success and challenges as the scale-upscale-up progressed to mature stages. The success included acceptability and institutionalization of the scale-up activities and growing enrolments and funds in the scheme. The challenges included: the costs to sustaining advocacy and enrolments, equity in scale-upscale-up activities across regions, relying on top-down scale-upscale-up approaches, influence of contextual factors and lack of implementation research alongside the scale-upscale-up process.</p><p><strong>Conclusion: </strong>This paper underscores the scale up steps and success and challenges of scaling-up a voluntary health insurance scheme in a resource-constrained health system. Sustaining the scale-upscale-up gains will require utilizing program data and experiences to sustainably improve the scheme performance while also harnessing support from stakeholders. Further research is needed to assess equity and quality of outcomes of the scale up.</p>","PeriodicalId":47054,"journal":{"name":"Cost Effectiveness and Resource Allocation","volume":"22 1","pages":"80"},"PeriodicalIF":1.7,"publicationDate":"2024-11-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11556162/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142629723","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}